Baker’s ‘test and trace’ gambit

Will contact tracing help get the state up and running?

GOV. CHARLIE BAKER, a data and systems guy from way back, has placed a big bet that a methodical approach to the coronavirus pandemic is what it will take to limit the virus’s spread and get the state up and running again. Specifically, he has hitched his wagon to a system known in public health circles as “test and trace.”

In this case, it means testing lots of people for the novel coronavirus and isolating those who are infected, while deploying an army of 1,000 interviewers to find out who those people had recent contact with and then reaching out to encourage those contacts to quarantine for 14 days to help break the chain of transmission of the contagion.

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In announcing the effort on April 3, Baker said the state was “breaking new ground in the fight against COVID-19,” boasting that Massachusetts was the first state to launch such a system.

But will the approach work?

A lot depends on “issues of timing, planning, and scale that are still being figured out,” according to a report issued today by the Center for State Policy Analysis at Tufts University. The policy brief says the strategy is fraught with elements that could fall short, and it involves lots of tradeoffs between privacy and quickly gaining access to thorough information.

The Massachusetts effort, being carried out in collaboration with the Boston-based global nonprofit Partners in Health, was spurred largely by the successful test and trace approach used in South Korea, Singapore, and Taiwan. But those countries’ approaches are highlighted by enormous government intrusion to quickly access information, an invasion of privacy that seems unlikely to be tolerated here.

The report says a huge increase in testing is needed for the Massachusetts approach to be effective. The state would need to roughly double its testing from the current level of 5,000 to 8,000 tests per day to 10,500 to 17,000, according to the Tufts analysis. The need to ramp up testing is made clear, the report says, by the high rate of positive findings in US testing — about 20 percent nationally, with an even higher rate of 25 percent in Massachusetts. Those figures suggest testing has been too narrowly focused on only those showing possible COVID-19 symptoms.

In addition to a lot more testing, the report says it will be crucial that the state effort quickly determine an infected person’s recent contacts and then reach those people to let them know they’ve been exposed to the virus. “The fact that asymptomatic people can spread Covid-19 complicates the work of contact tracing — and puts a premium on speed,” says the report. The efforts in Asian countries largely relied on “digital footprints” from cellphones through which massive amounts of data about the movement of people can be quickly harnessed. But that ‘“raises serious concerns about privacy and surveillance,” the report says.

The Massachusetts effort is relying instead on one-on-one phone interviews to obtain that information. The state initiative was the subject of a lengthy story in the New York Times last week. In it, Partners in Health cofounder Paul Farmer, a physician acclaimed for his public health work in developing countries, said the human contact from interviewers is invaluable in helping form a bond of trust with frightened patients.

But it can also slow the process down compared with the Asian models that have relied on technology to map contacts. A Brigham and Women’s Hospital physician who worked on the Ebola crisis in Africa told the Times that the interview-based approach means you have to “manually figure out where someone went,” giving more time for virus transmission among unsuspecting contacts.

About Michael Jonas

Michael Jonas has worked in journalism in Massachusetts since the early 1980s. Before joining the CommonWealth staff in early 2001, he was a contributing writer for the magazine for two years. His cover story in CommonWealth's Fall 1999 issue on Boston youth outreach workers was selected for a PASS (Prevention for a Safer Society) Award from the National Council on Crime and Delinquency.

Michael got his start in journalism at the Dorchester Community News, a community newspaper serving Boston's largest neighborhood, where he covered a range of urban issues. Since the late 1980s, he has been a regular contributor to the Boston Globe. For 15 years he wrote a weekly column on local politics for the Boston Sunday Globe's City Weekly section.

Michael has also worked in broadcast journalism. In 1989, he was a co-producer for "The AIDS Quarterly," a national PBS series produced by WGBH-TV in Boston, and in the early 1990s, he worked as a producer for "Our Times," a weekly magazine program on WHDH-TV (Ch. 7) in Boston.

Michael lives in Dorchester with his wife and their two daughters.

About Michael Jonas

Michael Jonas has worked in journalism in Massachusetts since the early 1980s. Before joining the CommonWealth staff in early 2001, he was a contributing writer for the magazine for two years. His cover story in CommonWealth's Fall 1999 issue on Boston youth outreach workers was selected for a PASS (Prevention for a Safer Society) Award from the National Council on Crime and Delinquency.

Michael got his start in journalism at the Dorchester Community News, a community newspaper serving Boston's largest neighborhood, where he covered a range of urban issues. Since the late 1980s, he has been a regular contributor to the Boston Globe. For 15 years he wrote a weekly column on local politics for the Boston Sunday Globe's City Weekly section.

Michael has also worked in broadcast journalism. In 1989, he was a co-producer for "The AIDS Quarterly," a national PBS series produced by WGBH-TV in Boston, and in the early 1990s, he worked as a producer for "Our Times," a weekly magazine program on WHDH-TV (Ch. 7) in Boston.

Michael lives in Dorchester with his wife and their two daughters.

The Asian experience also shows that even the best conceived plans can fail when there are holes in them.

After a highly successful first-wave effort put a lid on the virus by using contact tracing and making testing widely available, Singapore was jolted by a sudden doubling of cases in recent days, a surge centered in dormitories housing migrant laborers. The experience of the prosperous Southeast Asian city-state now stands as a harrowing cautionary tale for the US and other countries.

The goal of the Massachusetts effort is to help the state return to some semblance of normal life. The sudden surge of cases in Singapore, the New York Times reported on Monday, “suggests it might be difficult for the United States, Europe, and the rest of the world to return to the way they were anytime soon, even when viral curves appear to have flattened.”